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Colorado Building Up Millions In Unpaid Medicaid Claims

By Karen Morfitt

DENVER (CBS4) - Colorado doctors and hospitals are claiming they're owed hundreds of thousands, if not millions of dollars, in unpaid Medicaid claims.

It's a problem that stems from the implementation of the stat's new Medicaid payment system - which officially launched back in March.

Colorado doctors, after months of trying to work through the issues, say they're fed up with the site.

First it was individual doctors speaking out, but now it's hospital CEO's like Kevin Stansbury of Hugo's Lincoln Community Hospital who are saying they're stretched dangerously thin.

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Kevin Stansbury (credit: CBS)

"We are a small place. We do not generate a lot of revenue, so every dollar we generate is important to us. We currently have about $1.3 million wrapped up in unpaid claims with Medicaid," Stansbury said.

The state recognizes there have been issues.

Executive Director of Colorado's Department of Health Care Policy and Financing, Sue Birch, spoke in front of the Joint Budget Committee on Thursday.

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(credit: CBS)

"I want to start by fully acknowledging that this transition has been incredibly complex, not only for the state but for our providers and our other stakeholders," Birch said.

With such a complex system, the department's Health Information Director, Chris Underwood, says they expected there would be some growing pains.

"We also did some major policy changes when we implemented the system, and so a lot of providers believe the system is broken when the reality is we've changed our policy," Underwood said.

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Chris Underwood (credit: CBS)

The state does provide a number of tools to help providers navigate that system.

Call centers and interim "Hardship Payments" are among those, but providers say, like the system itself, those tools aren't working.

"We tried to call the Medicaid system to get some help and unfortunately they didn't know what was happening either," Stansbury said.

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"Healthcare is complicated, health care billing is even more complicated. Training individuals to be able to answer a provider's detailed question is actually very hard. We are working with our vendor to do that," Underwood said in response.

At a legislative hearing, Underwood set a goal of having things operating as normal by January.


"At this point, we are still being reactive to finding issues. But we are still trying to be proactive as we move forward," he said.

A majority of those committee members questioned that goal, saying the information did not add up for many of them who are now hearing directly from constituents.

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(credit: CBS)

State Representative Jonathan Singer, a Democrat from Longmont, was one of them.

"It's pretty scary when I hear somebody who's saying 'I haven't written myself a check for four months and I"m taking out a line of credit, and on top of that I can't take on any more Medicaid patients,'" he said.

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Jonathan Singer (credit: CBS)

The state has told CBS4 that it has "paid more than $24 million in interim payments to providers experiencing financial hardship.

They say any Medicaid-enrolled provider having financial difficulty can request an interim payment by calling DXC Technology at 844-235-2387, press option 2 and then option 4.



Karen Morfitt joined the CBS4 team as a reporter in 2013. She covers a variety of stories in and around the Denver metro area. Connect with her on Facebook, follow her on Twitter @karenmorfitt or email her tips.

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